Diagnosis of Chronic nonbacterial prostatitis
Chronic nonbacterial prostatitis Diagnosis: Book Excerpts
Diagnostic Tests for Chronic nonbacterial prostatitis: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about diagnostis of Chronic nonbacterial prostatitis.
PELVIC PAIN:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there a pelvic mass? The presence of a pelvic mass would suggest salpingo-oophoritis, ectopic pregnancy, endometriosis, uterine fibroid, or an ovarian tumor that is twisting on its pedicle.
- Is there fever or purulent vaginal discharge? The presence of fever or purulent vaginal discharge would suggest PID, diverticulitis, and appendicitis.
- Is there a history of metrorrhagia or menorrhagia? The history of metrorrhagia or menorrhagia would suggest ectopic pregnancy, threatened abortion, retained secundinae, uterine fibroids, and endometriosis.
- Is there a positive pregnancy test? The presence of a positive pregnancy test would suggest an ectopic pregnancy or threatened abortion.
- Is the pain related to the menstrual cycle? If the pain is related to the menstrual cycle, mittelschmerz should be considered.
DIAGNOSTIC WORKUP
Routine studies include a CBC, sedimentation rate, pregnancy test, urinalysis, urine culture, chemistry panel, VDRL test, and Pap smear. A vaginal smear and culture should also be done routinely.
The next step would logically be a pelvic ultrasound, but it is wise to consult a gynecologist before ordering expensive tests. The gynecologist may proceed with laparoscopy, culdocentesis, and, ultimately, an exploratory laparotomy. A CT scan of the abdomen and pelvis may also be necessary.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Pelvic Pain - Female:
Differential Diagnosis
(In a Page: Signs and Symptoms)
Acute pain (<6 months)
-
Pregnancy-related
–Ectopic pregnancy
–Threatened abortion
–Incomplete abortion
–Septic abortion
–Ruptured corpus luteal cyst
-
Gynecologic (noncyclic)
–Ovarian cyst
–Pelvic inflammatory disease
–Tubo-ovarian abscess
–Vaginitis/cervicitis
–Ovarian torsion
–Uterine fibroids
–Pelvic (ovarian, uterine, urinary) neoplasm
–Pelvic floor prolapse (cystocele/rectocele)
-
Gynecologic (cyclic pain)
–Primary dysmenorrhea
–Endometriosis
–IUD
–Mittelschmerz (midcycle ovulation) -
Nongynecologic
–Irritable bowel syndrome
–UTI/pyelonephritis
–Nephrolithiasis
–Appendicitis
–Diverticulitis
–Sexual abuse/trauma
–Abdominal aortic aneurysm
–Mesenteric ischemia/infarction
-
Chronic pain (>6 months) -
Very difficult to diagnose; differential includes gynecologic and nongynecologic etiologies (above), as well as the following
–Pelvic adhesions
–Interstitial cystitis
–Inflammatory bowel disease
–Adenomyosis
–Leiomyoma (fibroids)
–Hernia (femoral or inguinal)
–Depression
–Irritable bowel syndrome
–Diverticulosis or diverticular abscess
–Lymphoma
-
Less common etiologies (“zebras”) include pelvic congestion syndrome, mesenteric adenitis, surgical adhesions, Asherman's syndrome, foreign body (e.g., tampon), abdominal wall nerve entrapment, and porphyria
Workup and Diagnosis
- History and physical examination
–Note the nature, severity, onset, radiation, duration of pain; relation to menstrual cycle, intercourse, or other activities; chronic versus acute; chance of pregnancy
–Note associated symptoms: Fever, nausea, vomiting, dysuria, frequency, vaginal bleeding/discharge, abdominal or back pain
–Screen for domestic violence and sexual abuse
–Full abdominal and pelvic exams, including speculum, bimanual, and rectal exam
-
Laboratory studies may include urine pregnancy test, urinalysis, urine Gram stain and culture, cervical cultures for Chlamydia and gonorrhea, and wet mount of vaginal smear
-
Consider ultrasound if ovarian cyst, torsion, or mass is suspected, or to evaluate for intrauterine versus ectopic pregnancy
-
Diagnostic laparoscopy for acute abdomen or endometriosis
'>
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
PROSTATIC MASS OR ENLARGEMENT:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The main consideration in diagnosing a prostatic mass is to rule out carcinoma. It is therefore wise to draw blood for PSA before proceeding in anyone that is suspected of prostate cancer. If the mass is located in the posterior lobes, there is further support for the diagnosis. Ultrasonography can be done for further localization before proceeding with a biopsy. Obviously, if the PSA is positive, referral to a urologist is mandatory, although false-positives can occur in this test. A large, boggy prostate suggests a prostatic abscess or prostatitis. If there is no urethral discharge, one can elicit a discharge by prostatic massage. However, this should not be done if the patient has fever and significant tenderness of the prostate. It is better to proceed with antibiotic therapy and reexamine the patient after the fever has subsided. A smear and culture of the discharge is made. If upon examining the discharge under high-power microscopy, four or more WBCs per high-power field are found, the diagnosis of prostatitis can be made. If benign prostatic hypertrophy is suspected, cystoscopy and retrograde pyelography can be done.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
PELVIC PAIN:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
A good pelvic and rectal examination is essential. These will often disclose a mass or other pathology to explain the pain. If there is a vaginal discharge, a smear and culture for gonococcus and Chlamydia need to be done. A pregnancy test will help rule out an ectopic pregnancy, but ultrasonography is most useful.
A gynecology consult should be obtained when there is any doubt. In acute cases, the gynecologist may proceed with an exploratory laparotomy immediately.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Benign prostatic hyperplasia:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Clinical features and a rectal examination are usually sufficient for diagnosis. Other findings help to confirm it:
❑ Excretory urography may indicate urinary tract obstruction, hydronephrosis, calculi or tumors, and filling and emptying defects in the bladder.
❑ Elevated blood urea nitrogen and serum creatinine levels suggest renal dysfunction.
❑ Urinalysis and urine culture show hematuria, pyuria and, when the bacterial count exceeds 100,000/µl, urinary tract infection (UTI).
When symptoms are severe, a cystourethroscopy is definitive, but this test is performed only immediately before surgery to help determine the best procedure. It can show prostate enlargement, bladder wall changes, and a raised bladder.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Prostatic cancer:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
A digital rectal examination that reveals a small, hard nodule may help diagnose prostatic cancer. The American Cancer Society advises a yearly digital examination for men older than age 40, a yearly blood test to detect prostate-specific antigen (PSA) in men older than age 50, and ultrasound if abnormal results are found.
CONFIRMING DIAGNOSIS A biopsy confirms the diagnosis of prostatic cancer. PSA levels will be elevated in all men with metastatic prostatic cancer. Serum acid phosphatase levels will be elevated in two-thirds of men with metastatic prostatic cancer.
Therapy aims to return the serum acid phosphatase level to normal; a subsequent rise points to recurrence. Magnetic resonance imaging, computed tomography scan, and excretory urography may also aid diagnosis.
Elevated alkaline phosphatase levels and a positive bone scan point to bone metastasis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Prostatitis:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Characteristic rectal examination findings suggest prostatitis. In many cases, a urine culture can identify the causative infectious organism.
CONFIRMING DIAGNOSIS A firm diagnosis depends on a comparison of urine cultures of specimens obtained by the Meares and Stamey technique. This test requires four specimens: one collected when the patient starts voiding (voided bladder one); another midstream; another after the patient stops voiding and the physician massages the prostate to produce secretions (expressed prostate secretions; and a final voided specimen. A significant increase in colony count in the prostatic specimens confirms prostatitis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Chronic Pelvic Pain:
History
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
As with any pain, the onset, duration, and pattern of the pain must be assessed. The location, intensity, character, and radiation are important historical elements. Aggravating or relieving factors are important, especially as they relate to the urinary, musculoskeletal, or gastrointestinal systems as well as the relationship of pain to sexual activity or menstruation. Systemic symptoms such as fatigue and anorexia are often present. A medication history (e.g., use of birth control pills or over-the-counter medications) should be obtained. The past obstetric, gynecologic, and general surgical histories are extremely important.
It should be noted that women with a history of pelvic inflammatory disease are four times more likely to develop chronic pelvic pain. The list of possibilities for the condition is substantial. A person with intestinal, sexual, urinary, musculoskeletal, and systemic symptoms may be suffering from a psychiatric disorder (e.g., depression) and an acknowledged or remote history of sexual abuse. Often this information is possible to obtain only when the provider creates an atmosphere of mutual respect and trust.
Dyspareunia is often present. Cyclic pain that is related to menstruation usually points to a gynecologic problem. Pain referred to the anterior thigh, pain associated with irregular uterine bleeding, or new onset dysmenorrhea may have a uterine or ovarian cause. Urethral tenderness, dysuria, or bladder pain suggests interstial cystitis or a urethral problem (Chapter 10.1). Pain on defecation, melana, bloody stools, or abdominal pain with alternating diarrhea and constipation can point toward pelvic floor problems, irritable bowel syndrome, or inflammatory bowel diseases.
Physical examination
A. The general condition of the patient should be noted. Does the patient look chronically ill, which may suggest a pelvic lesion or an inflammatory bowel disorder? Does the patient appear anxious, stressed, or inappropriate?
1. Can the patient point to the pain with one finger? If so, this can indicate that the pain may have a discrete source.
2. An examination of the lower back, sacral area, and coccyx, including a neuologic examination of the lower extremities, is necessary. Herniated disc, exaggerated lumbar lordosis, and spondylolisthesis can all cause pelvic pain.
3. Examine the abdomen, looking for surgical scars, distension, and palpable tenderness, particularly in the epigastrium, flank, back, or bladder.
B. A thorough pelvic examination is the most important part of the evaluation.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Prostate Abnormality:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Benign prostatic hypertrophy
❑ Acute bacterial prostatitis
❑ Chronic prostatitis
❑ Adenocarcinoma
❑ Prostatic calculus
❑ Prostatic abscess
Diagnostic Approach
History helps in risk stratification: Men with a first degree relative with prostate cancer have a 2 to 3 fold increased incidence of prostate cancer. With 2 first degree relatives, this increases 5 to 8 fold.
The normal prostate is heart-shaped with a median raphe and a mass of 20 to 25 g. Carefully examine the posterior surfaces of the lateral lobes because this is where most prostate cancer originates. In screening for prostate cancer, digital rectal examination (DRE) looking for nodules, induration, or asymmetry may help to calibrate PSA values in the “gray zone” of 4 to 10. For example, a large gland may offer an explanation for a mildly elevated PSA, but a small gland or one with induration or asymmetry should heighten suspicion of prostate cancer. The positive predictive value for prostate cancer of an abnormal finding on DRE is 15% to 30%, increasing odds 1.5- to 2-fold. Because of low sensitivity, the value of a negative DRE to rule out prostate cancer is low. Men with an abnormality on DRE and a PSA ,4 still have a probability of prostate cancer of 12%, so biopsy is usually recommended. Examination followed by biopsy of any prostate nodule is the appropriate tactic because the clinical examination alone is not accurate enough in distinguishing benign causes from adenocarcinoma.
New suspicious findings on DRE in a patient with an initial negative baseline helps to select for aggressive tumors. Cancer found based on the first DRE has a 5 year prostate cancer mortality of 3% and 10 year mortality of 14%. Cancer found on a subsequent DRE has mortalities of 19% and 43% respectively.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Benign prostatic hyperplasia:
Diagnosis
(Handbook of Diseases)
Signs and symptoms and a rectal examination are usually sufficient for a diagnosis. Other test findings help to confirm it.
❑ Excretory urography may indicate urinary tract obstruction, hydronephrosis, calculi or tumors, and filling and emptying defects in the bladder.
❑ Elevated blood urea nitrogen and serum creatinine levels suggest impaired renal function.
❑ Urinalysis and urine culture show hematuria, pyuria and, when the bacterial count exceeds 100,000/µl, urinary tract infection.
With severe symptoms, a cystourethroscopy is definitive, but this test is performed only immediately before surgery to help determine the best procedure. It can show prostate enlargement, bladder wall changes, and a raised bladder.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Prostatic cancer:
Diagnosis
(Handbook of Diseases)
A digital rectal examination that reveals a small, hard nodule may help diagnose prostatic cancer. The American Cancer Society advises a yearly digital examination for men older than age 40, a yearly blood test to detect prostate-specific antigen (PSA) in men older than age 50, and ultrasonography if abnormal results are found.
Biopsy confirms the diagnosis. PSA is produced by the normal neoplastic ductal epithelium of the prostate and secreted into the lumen; its concentration in the blood is proportional to the total prostate mass. PSA levels will be elevated in all patients with prostatic cancer, and serum acid phosphatase levels will be elevated in two-thirds of men with metastatic prostatic cancer. Therapy aims to return the serum acid phosphatase level to normal; a subsequent rise points to recurrence. Magnetic resonance imaging, computed tomography scan, and excretory urography may also aid the diagnosis.
CLINICAL TIP: Elevated alkaline phosphatase levels and a positive bone scan point to bone metastasis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Prostatitis:
Diagnosis
(Handbook of Diseases)
Although a urine culture can usually help identify the causative infectious organism and rectal examination findings may suggest prostatitis, firm diagnosis depends on a comparison of urine cultures of specimens obtained by triple-void urine specimens. This test requires three specimens:
❑ one collected when the patient starts voiding (voided bladder one [VB1])
❑ another specimen collected midstream (VB2)
❑ another specimen collected after the patient stops voiding and the physician massages the prostate to express prostate secretions.
A significant increase in colony count in the prostatic specimens confirms prostatitis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
PROSTATIC MASS OR ENLARGEMENT:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The main consideration in diagnosing a prostatic mass is to rule out
carcinoma. It is therefore wise to draw blood for prostate-specific antigen
(PSA) before proceeding in anyone who is suspected of having prostate
cancer. If the mass is located in the posterior lobes, there is further
support for the diagnosis. Ultrasonography can be done for further
localization before proceeding with a biopsy. Obviously, if the PSA test is
positive, referral to a urologist is mandatory, although false-positives can
occur in this test. A large, boggy prostate suggests a prostatic abscess or
prostatitis. If there is no urethral discharge, one can elicit a discharge
by prostatic massage. However, this should not be done if the patient has
fever and significant tenderness of the prostate. It is better to proceed
with antibiotic therapy and reexamine the patient after the fever has
subsided. A smear and culture of the discharge is made. If upon examining
the discharge under high-power microscopy, four or more white blood cells
(WBCs) per high-power field are found, the diagnosis of prostatitis can be
made. If benign prostatic hypertrophy is suspected, cystoscopy and
retrograde pyelography can be done.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
PELVIC PAIN:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
A good pelvic and rectal examination is essential. These will often
disclose a mass or other pathology to explain the pain. If there is a
vaginal discharge, a smear and culture for gonococcus and Chlamydia need to be done.
A pregnancy test will help rule out an ectopic pregnancy, but
ultrasonography is most useful.
A gynecology consult should be obtained when there is any doubt. In acute
cases, the gynecologist may proceed with an exploratory laparotomy
immediately.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Chronic pain can affect a person 24 hours a day. What causes chronic pain? And how can you get some relief?
If you are suffering from abnormal bleeding, you may have submucus fibroid tumors. These tumors can cause severe cramping, fatigue, heavy menstrual...
For many doctors, hysteroscopy represents a great leap forward in gynecology. Others have been slower to embrace this new technology. What should...
For many women, any gynecologic procedure is an unattractive prospect, and something with a name like "hysteroscopy" sounds downright frightening. In...
See full list of 21 related videos
» Next page: Signs of Chronic nonbacterial prostatitis
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
